Cancer information comprehension by English-as-a-second-language immigrant women

Health Literacy, Language, and Cancer-Related Needs in the First 6 Months After a Breast Cancer Diagnosis

PURPOSE

Low health literacy (HL) and language negatively affect cancer screening and prevention behaviors; less is known about how they affect the patient's experience during cancer treatment. This study explores associations among HL, spoken language, and dimensions of cancer-related needs within 6 months of receiving a breast cancer diagnosis.

METHODS

Women speaking English, Spanish, or Haitian Creole, enrolled in a patient navigation study at diagnosis, completed a survey in their primary spoken language at baseline and 6 months to characterize their cancer-related needs. HL was measured using the Brief Health Literacy Screening Tool. Outcomes included the Cancer Needs Distress Inventory (CaNDI; n = 38 items) and the Communication and Attitudinal Self-Efficacy scale (CASE-Cancer) for cancer (n = 12 items). Linear regressions measured the impact of HL and language on total CaNDI and CASE-Cancer scale for cancer scores and subscales, adjusted for demographics.

RESULTS

At baseline, 262 women participated and 228 (87%) followed up at 6 months. Of these, 38% had adequate HL, 33% had marginal HL, and 29% had inadequate HL. Women with inadequate or marginal HL had higher median baseline CaNDI scores (P = .02) and lower self-efficacy scores (P = .008), relative to those with adequate HL. Haitian-Creole speakers had significantly lower CANDI scores at baseline (P = .03). Adjusting for demographics, differences in CaNDI scores at baseline remained significant for those with lower HL and Haitian-Creole speakers. At 6 months, differences in self-efficacy persisted for Haitian-Creole speakers.

CONCLUSION

Findings suggest that interventions oriented to mitigating HL and language barriers might reduce distress at the time of diagnosis and improve self-efficacy over the course of treatment.

Segmentation of Mexican-Heritage Immigrants: Acculturation Typology and Language Preference in Health Information Seeking

With the fast growing number of Mexican immigrants in the United States, more attention is needed to understand the relationship between acculturation and language preference in health information seeking. Latent class analysis provides one useful approach to understanding the diversity in sample of Mexican immigrants (N = 238). Based on 13 linguistic, psychological and behavioral indicators for acculturation, four discrete subgroups were characterized: (1) Less acculturated, (2) Moderately acculturated, (3) Highly acculturated, (4) Selectively bicultural. A Chi-square test revealed that three sub-groups were significantly different in language preference when seeking health information. Less acculturated and moderately acculturated groups sought health information in Spanish, whereas the highly acculturated group preferred English for health information. Selectively bicultural group preferred bilingual health information. Implications for health campaign strategies using audience segmentation are discussed.

Development of health literacy scale among Brazilian mothers in Japan

Japanese-Brazilians were the third largest immigrant group in Japan in 2011. Their health issues have caused concern, as their limited language made them vulnerable by hindering access to health services. Upon considering child health, mothers' health literacy (HL) is very important. This study aimed to develop a health literacy scale among Brazilian mothers (HLSBM) in Japan. Questionnaires in Portuguese were distributed to 1474 mothers from December 2011 to March 2012. Among 698 collected, 558 questionnaires were analyzed. We prepared 29 candidate items for HLSBM based on Nutbeam's concept of functional, interactive and critical literacy. The dimensional structure was determined statistically using confirmatory factor analysis. Validity was also analyzed by Pearson's correlation with Ishikawa's scale and Kendall's coefficient of concordance among researchers. Cronbach's α coefficients were calculated to examine internal consistency. The confirmatory factor analysis revealed a two-factor model (five items for basic literacy and five items for critical literacy) with sufficient goodness of fit (GFI 969, AGFI 945, NFI 959, CFI 972, RMSEA 060). The internal consistency values of the total score, basic and critical literacy sub-scales were 0.819, 0.889 and 0.667, respectively. Kendall's coefficient of concordance showed good agreement of researchers (p < 0.001). Pearson's correlation coefficients with Ishikawa's scale were 0.554 for total score, 0.446 for basic literacy and 0.472 for critical literacy. The HLSBM consisting of two factors was confirmed to be valid and reliable. The HLSBM must be useful for understanding this vulnerable group's health literacy and its associated factors.

Predictors of non-adherence to colorectal cancer screening among immigrants to Ontario, Canada: a population-based study

Though colorectal cancer (CRC) screening rates have increased over time in Ontario, Canada, immigrants continue to have lower rates of screening. This study examines the association between non-adherence to CRC screening and immigration, socio-demographic, healthcare utilization, and primary care physician characteristics among immigrants to Ontario. This is a population-based retrospective cross-sectional study that uses healthcare administrative databases housed at the Institute for Clinical Evaluative Sciences. Our cohort comprised immigrants aged 60 to 74 years who lived in Ontario on March 31, 2015 and who had been eligible for the Ontario Health Insurance Plan for at least 10 years. The outcome was lack of adherence to CRC screening with any modality (fecal occult blood test, flexible sigmoidoscopy, colonoscopy) on March 31, 2015. Our cohort contained 182,949 immigrants. Overall 70,134 (38%) individuals were not adherent to screening. Risk of non-adherence to CRC screening was higher among immigrants who were from low (adjusted relative risk [ARR] 1.35, 95%CI 1.28-1.42) or low-middle (ARR 1.27, 95%CI 1.24-1.30, population-attributable risk [PAR] 9.8%) income countries and refugees (ARR 1.09, 95%CI 1.06-1.11). Compared to those from the United States, Australia, and New Zealand, immigrants from most other world regions, particularly Eastern Europe and Central Asia (ARR 1.28, 95%CI 1.21-1.37), had higher risks of non-adherence. Non-immigration factors such as low healthcare use and lack of primary care enrolment also increased the risk of non-adherence to screening. These findings can be used to inform future efforts to improve uptake of CRC screening among immigrant groups.

Understanding Cervical Cancer Screening among Latinas through the Lens of Structure, Culture, Psychology and Communication

This study explored how structural and cultural forces work together with psychological and communication factors in influencing Pap test compliance among Latinas in Los Angeles County, a group who face health disparities related to cervical cancer screening, incidence and mortality. By adopting a multilevel approach to obtain a grounded understanding of this issue, this work revealed that structural barriers, fatalism, religious service attendance, perceived susceptibility, perceived costs, and cues to action from health care providers are all associated with Pap test compliance. Financial barriers also influence compliance, with underinsurance having a stronger negative impact compared to no insurance at all. These findings provide insights into how communication efforts can be strategically designed to address both individual- and system-level barriers to promote health-seeking behaviors among Latinas, and potentially among other population groups experiencing health disparities due to similar reasons.

Health literacy and cancer screening: a systematic review

OBJECTIVE

To evaluate published evidence about health literacy and cancer screening.

METHODS

Seven databases were searched for English language articles measuring health literacy and cancer screening published in 1990-2011. Articles meeting inclusion criteria were independently reviewed by two investigators using a standardized data abstraction form. Abstracts (n=932) were reviewed and full text retrieved for 83 articles. Ten articles with 14 comparisons of health literacy and cancer screening according to recommended medical guidelines were included in the analysis.

RESULTS

Most articles measured health literacy using the S-TOFHLA instrument and documented cancer screening by self-report. There is a trend for an association of inadequate health literacy and lower cancer screening rates, however, the evidence is mixed and limited by study design and measurement issues.

CONCLUSION

A patient's health literacy may be a contributing factor to being within recommended cancer screening guidelines.

PRACTICE IMPLICATIONS

Future research should: be conducted using validated health literacy instruments; describe the population included in the study; document cancer screening test completion according to recommended guidelines; verify the completion of cancer screening tests by medical record review; adjust for confounding factors; and report effect size of the association of health literacy and cancer screening.

Colon cancer information preferences of English-as-a-second-language immigrant women: does language of interview matter?

Language of interview, an acculturation proxy measure, may differentiate between cancer information preferences of English-as-a-second-language (ESL) immigrant women in Canada. Using directed content analysis, we compared 28 interviews conducted in Spanish or English. Demographic comparisons were completed using paired t tests and McNemar related samples. Themes identified were: (1) using English language information and (2) improving information for ESL speakers. No differences were found in women's conversations about colon cancer by age, income, education, or employment. However, English interviewees resided in Canada longer and watched less television. Language skill and contextual factors influence women's confidence using English cancer information.